Hypertensive Disorders of Pregnancy in Patients With Cardiac Disease: Risk and Impact on Delivery Timing

Pregnant patients with cardiovascular disease (CVD) face increased risk of hypertensive disorders of pregnancy (HDP) and preterm delivery, yet data are limited regarding the degree of risk and impact of HDP on gestational age at delivery.

The objective of the study was to examine the HDP risk and impact on gestational age at delivery in patients with CVD.

This retrospective cohort study used the Premier Healthcare Database and included patients >18 years who delivered between October 1, 2015, and December 31, 2020. Patients with CVD were categorized into the following 6 subtypes: congenital, ischemic, aortic pathology, pulmonary hypertension (HTN), cardiomyopathy, and valvular disease. Primary outcome was odds of HDP (gestational HTN or pre-eclampsia); Secondary outcome was gestational age at delivery. Multivariable mixed effects regression models were used to estimate adjusted outcomes, adjusting for CVD subtype, >1 CVD subtype present, demographics, hospital characteristics, and comorbidities.

Among 4,606,247 obstetric patients, 20,021 had CVD. HDP risk varied by CVD subtype, lowest in those with congenital heart disease (adjusted OR [aOR]: 0.9; 95% CI: 0.8-1.0) and highest in those with pulmonary HTN (aOR: 1.5; 95% CI: 1.3-1.8) and cardiomyopathy (aOR: 1.5; 95% CI: 1.4-1.6). Patients with CVD delivered earlier than those without CVD, even in the absence of HDP (36.4-38.0 weeks vs 38.4 weeks). Among those with HDP, patients with severe pre-eclampsia with CVD, delivered earlier than those without CVD (33.1-34.6 weeks vs 35.5 weeks).

Odds of HDP and delivering at an earlier gestational age differs across CVD subtypes, notably higher in those with pulmonary HTN and cardiomyopathy, emphasizing the need for individualized counseling.